Health Care Report Cards: Managing Expectations

1
Health Care Report Cards Managing Expectations

• Denise Love
• National Association of Health Data Organizations

2
Discussion Outline

• Quality Measurement Framework and Driving Forces
• What are health care report cards?
• Who is producing report cards?
• Limitations
• What is the impact of report cards?
• Prepare yourself, the future is now

3
A Quality Measurement Framework
Process Immunization Rates Mammography Rates
Structure Ownership Plan Type
Outcomes
Objective Outcomes C-Section Rates Inpatient
Mortality Complications
Subjective Outcomes Patient Satisfaction
4
The National Agenda-----The Presidents Advisory
Commission on Consumer Protection and Quality in
the Health Care Industry
Final Report to the President 1998
The purpose of the health care system must be to
continuously reduce the impact and burden of
illness, injury, and disability, and to improve
the health and functioning of the people of the
United States
5
The National Quality Agenda

• Core sets of quality measures for standardized
  reporting
• A framework and capacity for measurement and
  reporting
• Valid, reliable, understandable, publicly
  available

6
Presidents Quality Interagency Coordination Task
Force (QuIC)
Coordinating all federal purchasing, regulatory,
research, and provider quality activities

• Improving patient and consumer information on
  health care quality
• Identifying key opportunities for improving
  clinical quality
• Improving efforts to measure quality of care.
• Developing the health care work force
• Improving information systems

7
Statewide Hospital Data CollectionMandated and
Voluntary
States with mandates to collect health care
systems data
Hospital Association or Private organization
collects statewide data voluntarily
No Mandate
August 1999
8
States Producing Health Plan Report
CardsMandated and Voluntary
August 1999
9
Whats Driving Quality Measurement?
The Market and Value Purchasing
Internet
Medical Error National Quality Agenda
Accountability
Managed Care
Consumer Empowerment
Medical Errors
HIPAA
Medicare Choice
10
(No Transcript)
11
What are report cards?

• A summary of statistics (rate, ratio, frequency)
  that
• provides interpretation
• compares multiple organizations
• is publicly available
• is independently validated

12
Report Cards are derived from measure sets

• Examples of Hospital Measure Sets
• Joint Commission on the Accreditation of Health
  Care Organizations (JCAHO) ORYX
• Agency for Healthcare Research and Quality
  (AHRQ) Healthcare Cost and Utilization Project
  (HCUP) Quality Indicators
• Picker Institute Hospital Patient Surveys

13
Report Cards are derived from measure sets

• Examples of Health Plan Measure Sets
• National Committee on Quality Assurance (NCQA)
  Healthplan Employer Data and Information Set
  (HEDIS)
• Agency for Healthcare Research and Quality
  (AHRQ) Consumer Assessment of Health Plan Survey
  (CAHPS)
• Foundation for Accountability (FACCT)

14
Report Cards--No Escapeeveryone is using (or
planning to use) them

• Medicare Choice
• Federal Employees Benefit Health Plans
• Purchasers/Employers
• State governments
• state health data agencies
• Medicaid Managed Care
• state insurance regulators/payers
• nursing home and home health regulators

15
Public Reporting--A balancing act.
Patient Privacy
Timeliness
Proprietary Concerns
Clinical Information
Accuracy
Relevance
Administrative data
Fairness
16
PREDICTED IMPACT OF HMO REPORT CARDS
17
ACTUAL IMPACT
Quality Improvement
Medicaid and Community Collaboration
Improved accountability and market
18
Why is the Consumer Impact Limited?
Consumers have a hard time understanding health
maintenance organization report cards.Because
working memory and thinking skills decline with
age, older consumers may find it particularly
difficult to interpret government-sponsored
report cards. Hochhauser, Managed Care
Quarterly, Health Maintenance Organization
Report Cards Communication Strategies vs.
Consumer Abilities, 1999
19
Evaluating the EvaluatorsMark Hochhauser Ph.D,
2000

• Do they meet the plain English requirement?
• Florida A
• Maryland, New Jersey, Kansas, Texas B
• New Mexico, Utah, Minnesota C
• Missouri D
• Connecticut F

Indices based on Flesch Reading Ease, Flesch
Human Interest Score, Word Commonness, Active
Voice Sentences, Sentence Comparison, and Reading
Grade Level
20
What information consumers want
Outcomes Physicians HMOs/plans
Hospital Data
-

Relative difficulty in obtaining information
Outcomes Physicians HMOs/plans
Hospital Data
-

D. Love, NAHDO 2000
21
The Challenges and Opportunities
22
HMO REPORT CARD FORMAT AND GROUPING Technical
and Political Considerations
A B C D
NAHDO, 2000
23
A Look At The Inside
24
PHC4s Next Managed Care Project?

• Comprehensive Manage Care Performance Report
• Outcome Data Similar to the HPR
• Process Information Similar to DR

25
Limitations

• Health care organizations vary widely in data
  systems capacity and underlying data were
  designed for administrative purposes
• Audit and validation methods are evolving
• Report card analytic methods are inconsistent
  (adjustments, imputation of missing numbers)
• Correlation between measures and measure sets not
  well-understood

26
Despite the Limitations, Report Cards Serve a
Purpose

• Even if consumers are not using report cards,
  that does not mean they arent providing a
  valuable service. The people paying the closest
  attention to the scores are the health care
  organizations themselves---which is exactly what
  we, as purchasers, want them to be doing. One
  less thing for us to worry about.
• (A Sr. Vice President of HRM for a Corporate
  Bank--Milbank Meeting, 1999)

27
Utah HEDIS 1996
Plan D
28
Consumer Reporting

• Consumer Reports
• Newsweek
• U.S. News and World Report
• Wall Street Journal
• Local media
• Internet dot.coms

29
Informing or Confounding?

• Unlike their state counterparts, magazines
  provide a single summary score and ranking
• A single score/grade is easier for consumers to
  understand that complex state reports
• Unfortunately, these scores are often not
  consistent--even using the same data!

30
Why cant consumers understand report cards?
(courtesy of Mark Hochhauser, Ph.D.)

• My plan scored above average on 5 questions,
  average on 3, and below average on 2. Is this
  better than another plan scoring above average on
  3, average on 6, and below average on 1?
• One question with four possible results, for 15
  health plans, plus a state average64 numbers
• Ten questions640 numbers
• 5 or more domains of care scores

31
A Grain of Salt.
Torture numbers and theyll confess to anything.
Greg Easterbrook in the New Republic
32
The Future--Whats Next?

• Increased depth and uniformity in encounter data
  (under HIPAA) will lead to more comparative
  performance reporting
• Physicians
• True outcomes (complications/mortality)
• Consumer-friendly information
• Security Exchange Commission as a model for
  disseminating complex information
• National Quality Report Cards

33
Your organization will be ranked by someone,
somewhere..what to do?

• Ask questions
• What were the underlying data source(s)?
• Were all of the measures audited and validated?
  By whom? How? For all organizations in the
  report? Comparable timeframes?
• What were the analytic methods? How were
  missing/invalid measures handled?
• Drill down what were the measure or measures
  that influenced the total score?

34
Your organization will be ranked by someone,
somewhere..what to do?

• Be positive
• emphasize your organizations strengths
• explain, not defend, your weaknesses
• use this opportunity to leverage quality
  improvement with management
• Rememberthere is time to improve and prepare
  before consumers really understand and use this
  information

35
Resources

• Agency for Healthcare Quality and Research
  www.ahrq.gov
• Health Care Financing Administration
  www.hcfa.gov
• National Association of Health Data Orgs--health
  websites www.nahdo.org
• American Association of Health Plans
  www.aahp.org
• National Committee for Quality Assurance
  www.ncqa.org